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Coincident intracranial aneurysm in the target vessel of acute ischemic stroke treated with mechanical thrombectomy: a case control study

Introduction: Patients with Acute Ischemic Stroke (AIS) treated with mechanical thrombectomy (MT) may sometimes have a coincident intracranial aneurysm (CIA) in the target vessel. In this setting, the benefit of MT is uncertain. We aimed to assess the efficacy and safety of MT in cases of CIA on the target vessel.

Methods: We retrospectively analyzed data from 14 stroke centers in France and Switzerland from January 2015 to January 2023 to identify AIS with CIA on the target vessel treated with MT. The control population was constituted from a monocentric retrospectively collected database without CIA. Baseline characteristics, procedural variables, clinical and radiological outcomes were compared between the two groups. A multivariate model was conducted to assess risk factors for poor outcome according to procedural and aneurysm variables.

Results: 6287 MT were included in the cases group, from which we identified 101 cases with at least one CIA on the target vessel. 816 patients were included in the control group. No significant difference was observed in the clinical outcome (mRS at 3 months ≤ 2) between cases and controls: 36% vs. 43% (p = 0.350) nor in recanalization rates (mTICI ⩾2b): 90% and 83% (p=0.138). A 5% rate of aneurysm rupture was reported increasing the rate of intracranial hemorrhage to 31% versus 12% in the control group (p<0.001).

Conclusion: In selected patient with a CIA on the target vessel, MT may be associated to an increase rate of intracranial hemorrhage without significantly affecting the clinical outcome. Our study provides arguments for not contraindicating MT in this setting.

Keywords : Stroke, Mechanical Thrombectomy, Acute Ischemic Stroke-Large Vessel Occlusion, Aneurysm.